Anxiety and Depressive Symptoms in Moroccan Patients Following Major Lower Limb Amputation: A Three-Month Follow-Up.

OBJECTIVE: Major amputation of a lower limb is a traumatic experience that causes physical and psychosocial disabilities. This study set out to ascertain how anxiety and depression symptoms changed during the three months following the amputation. MATERIALS AND METHODS: A prospective longitudinal observational study was conducted between October 1, 2019, and January 1, 2021, in the Department of Vascular Surgery and the Department of Orthopedic Traumatology of the Ibn Sina Hospital Center in Rabat, Morocco. The study assesses symptoms of anxiety and depression in patients who have undergone a major lower limb amputation over a three-month interval. RESULTS: In patients who had undergone a major lower limb amputation, the prevalence of anxiety and depression symptoms was very high immediately postoperatively (47.4% and 79.2%, respectively), with a significant decrease in these symptoms. Three months later, anxiety was reported in 24.4% of cases, and depressive symptoms in 65.1% of cases. Age, amputation level, stump pain, phantom limb pain, re-amputation, and emergency amputation were all associated with an increased risk of anxiety and depression. The patient's psychological preparation prior to the amputation, the anesthetic technique used during the procedure, the patient's mobility, and the patient's post-amputation professional status were all protective factors. CONCLUSION: Our research findings bolster the necessity of promptly evaluating and managing anxiety and depression in the initial three months following major lower limb amputation. Thus, we believe that amputee patients ought to receive a formal psychological evaluation, which could be helpful, particularly for those whose anxiety or depression symptoms did not improve after three months.

Knowledge, Attitudes, and Practices of Moroccan Community Rheumatologists' Regarding the Management of Non-radiographic Axial Spondyloarthritis: A National Cross-Sectional Study.

Introduction Non-radiographic axial spondyloarthritis (nr-axSpA) is within the spectrum of axial spondyloarthritis (axSpA). The emergence of the nr-axSpA concept, defined by the absence of significant erosive damage to the sacroiliac joints, has prompted numerous initiatives aimed at enhancing the early detection and management of this condition. The aim of the study was to assess the knowledge, attitudes, and practices related to the diagnosis and management of nr-axSpA by rheumatologists in Morocco. Methods We conducted a cross-sectional online survey among the rheumatologist community in Morocco. Rheumatologists received via e-mail a structured Google Forms (Google Inc., Mountainview, CA) questionnaire divided into four sections: sociodemographic data of rheumatologists, knowledge, attitudes, and practices related to the diagnosis and treatment management of nr-axSpA. Results A total of 110 rheumatologists (mean age of 44±13 years, 77.3% females, median professional experience of 12 years (4, 75; 26.25 years)) participated in the survey (response rate of 25%). Most responders reported a diagnosis delay issue in spondyloarthritis (SpA) (93.6%); 70.9% of rheumatologists incorrectly regarded the 2009 Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axSpA as diagnostic criteria. Rheumatologists' awareness of recommended magnetic resonance imaging (MRI) sequences for detecting sacroiliac joint inflammation and structural changes in SpA varied significantly, from 69.1% to 14.5%. Their knowledge of additional subchondral edema cases in these joints, beyond SpA, ranged from 48.2% to 87.3%. Almost all rheumatologists believed that the use of sacroiliac MRI would contribute to the early diagnosis of axSpA (97.3%) but could also lead to false positive diagnoses, according to 47.3% of rheumatologists; 73.6% believed that incorrectly using the 2009 ASAS classification criteria as diagnostic criteria in nr-axSpA could also result in false-positive diagnoses. In their practice, 2009 ASAS classification criteria were used as diagnostic criteria in axSpA by 39.1% of rheumatologists. Of the total participants, 91.8% indicated that they approach nr-axSpA similarly to radiographic axial spondyloarthritis, with disparities in recommendations of biological therapies. Conclusion Our survey provides insight into the current status of nr-axSpA management among Moroccan rheumatologists. It also addresses concerns regarding the risk of false positive diagnoses when using the 2009 ASAS classification criteria for axSpA as diagnostic criteria by rheumatologists and the potential risk of misdiagnosis associated with excessive reliance on MRI, despite its utility for early diagnosis.

Evaluation of the effect of duration on dialysis on echocardiographic parameters: a preliminary study.

The excessive cardiovascular mortality seen in patients with end-stage renal disease seems to be closely related to accelerated coronary atherosclerosis. Some echocardiographic parameters such as left ventricular mass and diastolic dysfunction are implicated in ventricular dysfunction and mortality. The aim of the present study was to evaluate the effect of duration on dialysis on some echocardiographic parameters. We enrolled 75 patients on hemodialysis, including 34 women, in our prospective study. The mean age was 42.5 ± 13.8 years. The echocardiographic parameters were all measured within 2 h after a dialysis session. The study population was divided into two groups: Group-1 consisted of patients on dialysis for < 5 years and group-2 included patients on dialysis for >5 years. The two groups were similar regarding demographic characteristics and cardiovascular risk factors. On univariate analysis, a statistically significant difference was seen in the left ventricular end-diastolic diameter (P = 0.002), left ventricular end-syslotic diameter (P = 0.008), left ventricular mass (P = 0.006), inter-ventricular septum (P = 0.024), mitral flow deceleration time (P = 0.03), tricuspid anteroposterior systolic excursion (P = 0.01), inferior vena cava diameter (P = 0.04), left atrial size (P = 0.02), valvular calcification (P = 0.01) and pericardial effusion (P = 0.01) between the two groups. We conclude that the duration on dialysis is associated with changes in several echocardiographic parameters. Frequent follow-up with echocardiogram is recommended in the management of these patients.

Health related quality of life survey about children and adolescents with juvenile idiopathic arthritis.

This study aimed to investigate the proxy-reported Health related quality of life (HRQOL) and its determinants in patients with juvenile idiopathic arthritis (JIA). It was hypothesized that HRQOL would decrease with worsening disease and disability. Data were available in cross-sectional study on children and adolescents with JIA according to the ILAR criteria. Patient demographics, type of JIA, clinical determinants and laboratory parameters relating to JIA were obtained for each patient. Functional disability was assessed using the parent's or children's version of the child health assessment questionnaire (CHAQ). The HRQOL was evaluated using the juvenile arthritis quality of life questionnaire (JAQQ). These questionnaires were previously translated and validated in Moroccan children. A total of 80 participants were enrolled with mean age of 11 [6-17 years], and female predominance (59%). Many patients (42.5%) had oligoarticular subtype; 31.3% polyarticular subtypes and 26.2% systemic form. The mean global score of JAQQ was 2.6 +/- 1.3 (1-6). Patients with persistant oligoarticular had better gross motor function (P < 0.0001), better fine motor function (P < 0.0001), less psychosocial impact (P = 0.001), and less symptoms (P = 0.001) in comparison with polyarticular and systemic subtypes. The HRQOL assessed by the JAQQ was worse in adolescent patients in comparison with children except for symptoms (P = 0.15). The gender (P = 0.95), age at onset of JIA (P = 0.81), and evolution duration (P = 0.34) were not correlated with global score of JAQQ. The diagnosis delay was significantly associated with decrease of HRQOL (P = 0.001). The decrease of HRQOL was correlated with disease activity [pain (VAS), painful and swollen joints, erythrocyte sedimentation rate (for P < 0.0001)], with disability index (CHAQ) (P = 0.001) and presence of hip involvement (P = 0.01). This study suggests that JIA can have a significant adverse effect on the HRQOL of moroccan patients, particularly adolescents with polyarticular and systemic subtypes. Disease duration, disability score (CHAQ) and pain were the strongest determinants of poorer HRQOL.

[Therapeutic maintenance level of methotrexate in rheumatoid arthritis]. / Taux de maintenance thérapeutique: à propos du méthotrexate au cours de la polyarthrite rhumatoïde traitée au Maroc.

OBJECTIVES: To determine the probability of drug continuation, the reasons for discontinuation of methotrexate (MTX), and risk factors of treatment termination in rheumatoid arthritis. MATERIALS AND METHODS: Retrospective cohort study of a 100 case follow-up between 1983 and 2003, all treated with MTX. Factors associated with toxicity, and efficacy of MTX were studied. Logistic regression was used to study the relation between baseline variables and various dependent factors. RESULTS: Eighty three women and seventeen men were included in this study. The mean age at commencement of MTX was 45+/-13.7 (18-81) years. The mean duration of disease was 9.5+/-8.7 (0.25-40) years. The mean weekly dose of MTX was 9.8+/-3.4 mg/week. The therapeutic maintenance level of MTX was 76% at one year, 63% at 2 years and 45% at 5 years. The median of treatment duration was 10 (0. 5-40) months. Reasons for patients stopping MTX were: Adverse effects (15), lack of effect (1), non medical reasons (14) essentially because of financial difficulties. Baseline white blood cell counts >9 giga/mm3 (RR: 3.17) [95 %:1.03-9.74] (p=0.04) and baseline serum creatinine level >72 micromol/L (RR: 8.6) [95 %:1.04-71.17] (p=0.04) were associated with an increased risk of treatment termination. CONCLUSION: The continuation rate of methotrexate in our study was good, despite the poor compliance with the treatment due to financial difficulties.